Remote Nurse Managed Care Manager

Elevance Health; Atlanta (GA); Hybrid; USD 80,000 - 105,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager II to manage care for members with complex and chronic needs. The role supports assessment, development, implementation, coordination, monitoring, and evaluation of care plans to optimize health outcomes.

This hybrid/virtual position emphasizes flexibility, with mandatory in-person training sessions and weekly onsite requirements as per policy. Requires RN licensure and a health-related BA/BS, with 5+ years of clinical experience; Case Manager

Qualifications

• Requires BA/BS in a health-related field.
• Minimum 5 years of clinical experience.
• Current, unrestricted RN license in applicable state.
• Case Manager certification preferred.

Responsibilities

• Assess and identify member needs and develop a specific care management plan.
• Coordinate, implement, monitor, and evaluate care plans to optimize member health across the continuum.
• Interface with Medical Directors and Physician Advisors on care management treatment plans.
• Facilitate authorizations/referrals within benefits structure or through extra-contractual arrangements.
• Negotiate rates of reimbursement as applicable and support problem solving with providers.

Skills

RN license

Clinical experience

Case management experience

Education

BA/BS in health-related field

Job description

Nurse Case Manager II

Job Description:

Shift: M-F 9am-5:30pm with one 11:30am-8pm shift each week.

Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face‑to‑face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

The Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Ensures member access to services appropriate to their health needs.

Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.

Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra‑contractual arrangements.

Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.

Negotiates rates of reimbursement, as applicable.

Assists in problem solving with providers, claims or service issues.

Assists with development of utilisation/care management policies and procedures.

Requires BA/BS in a health related field and minimum of 5 years of clinical experience; Current, unrestricted RN licence in applicable state(s) required.

Certification as a Case Manager is preferred.

Non‑Management Exempt

Workshift:

1st Shift (United States of America) Job Family: Licensed Nurse

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market‑competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programmes (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programmes and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member‑facing roles to become vaccinated against COVID‑19 and Influenza. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, colour, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form:

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE

Workday keeps job postings active through 11:59:59 PM on the day before the listed end date.